title: Prevalence and correlates of bipolar spectrum disorder in the world mental health survey initiative.
abstract: BACKGROUND
  There is limited information on the prevalence and correlates of bipolar spectrum disorder in international population-based studies using common methods.
  
  
  OBJECTIVE
  To describe the prevalence, impact, patterns of comorbidity, and patterns of service utilization for bipolar spectrum disorder (BPS) in the World Health Organization World Mental Health Survey Initiative.
  
  
  METHODS
  Cross-sectional, face-to-face, household surveys of 61,392 community adults in 11 countries in the Americas, Europe, and Asia assessed with the World Mental Health version of the World Health Organization Composite International Diagnostic Interview, version 3.0, a fully structured, lay-administered psychiatric diagnostic interview.
  
  
  METHODS
  Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) disorders, severity, and treatment.
  
  
  RESULTS
  The aggregate lifetime prevalences were 0.6% for bipolar type I disorder (BP-I), 0.4% for BP-II, 1.4% for subthreshold BP, and 2.4% for BPS. Twelve-month prevalences were 0.4% for BP-I, 0.3% for BP-II, 0.8% for subthreshold BP, and 1.5% for BPS. Severity of both manic and depressive symptoms as well as suicidal behavior increased monotonically from subthreshold BP to BP-I. By contrast, role impairment was similar across BP subtypes. Symptom severity was greater for depressive episodes than manic episodes, with approximately 74.0% of respondents with depression and 50.9% of respondents with mania reporting severe role impairment. Three-quarters of those with BPS met criteria for at least 1 other disorder, with anxiety disorders (particularly panic attacks) being the most common comorbid condition. Less than half of those with lifetime BPS received mental health treatment, particularly in low-income countries, where only 25.2% reported contact with the mental health system.
  
  
  CONCLUSIONS
  Despite cross-site variation in the prevalence rates of BPS, the severity, impact, and patterns of comorbidity were remarkably similar internationally. The uniform increases in clinical correlates, suicidal behavior, and comorbidity across each diagnostic category provide evidence for the validity of the concept of BPS. Treatment needs for BPS are often unmet, particularly in low-income countries.
authors.affiliation: National Institute of Mental Health, Bethesda, MD 20892, USA. kathleen.merikangas@nih.gov
authors.forename: Kathleen R
authors.initials: KR
authors.lastname: Merikangas
authors.forename: Robert
authors.initials: R
authors.lastname: Jin
authors.forename: Jian-Ping
authors.initials: JP
authors.lastname: He
authors.forename: Ronald C
authors.initials: RC
authors.lastname: Kessler
authors.forename: Sing
authors.initials: S
authors.lastname: Lee
authors.forename: Nancy A
authors.initials: NA
authors.lastname: Sampson
authors.forename: Maria Carmen
authors.initials: MC
authors.lastname: Viana
authors.forename: Laura Helena
authors.initials: LH
authors.lastname: Andrade
authors.forename: Chiyi
authors.initials: C
authors.lastname: Hu
authors.forename: Elie G
authors.initials: EG
authors.lastname: Karam
authors.forename: Maria
authors.initials: M
authors.lastname: Ladea
authors.forename: Maria Elena
authors.initials: ME
authors.lastname: Medina-Mora
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Ono
authors.forename: Jose
authors.initials: J
authors.lastname: Posada-Villa
authors.forename: Rajesh
authors.initials: R
authors.lastname: Sagar
authors.forename: J Elisabeth
authors.initials: JE
authors.lastname: Wells
authors.forename: Zahari
authors.initials: Z
authors.lastname: Zarkov
mesh_terms: D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D001714:Bipolar Disorder / Q000453:epidemiology*; D015897:Comorbidity; D003431:Cross-Cultural Comparison; D003430:Cross-Sectional Studies; D003865:Major Depressive Disorder / Q000453:epidemiology; D005260:Female; D006306:Health Surveys; D006801:Humans; D008297:Male; D008605:Mental Health Services / Q000706:statistics & numerical data*; D008875:Middle Aged; D012737:Sex Factors; D012959:Socioeconomic Factors; D013406:Suicide, Attempted / Q000523:psychology / Q000706:statistics & numerical data; D014600:Utilization Review / Q000706:statistics & numerical data; D014944:World Health Organization; D055815:Young Adult